ZHealth News

September 2017 Q & A

Question: Limbs AV Fistula Declot & Stenting Failure; TPA and Repeat Stent for Extravasation

AV left forearm graft fistulogram showed extensive thrombus in main draining vein up to the level of the distal third of the humerus. Crossing sheaths placed. Angiojet catheter used to treat arterial and venous anastamosis. It worked for arterial but not venous. Angioplasty of arterial anastomosis, with arterial flow re-established. Stent was placed across venous anastamosis to improve outflow. Patient continued to clot despite administration of 10,000 units of heparin during the procedure. Multiple passes again made with the angiojet. Flow was not re-established.

Read More
Posted in Free Newsletters By Sondra Dunn

ZHealth Coding Newsletter - August 2017

Aug 28, 2017 2:22:00 AM

August 2017 Q & A

Question: Repair of EVAR with Deployment of 2 Gore Excluder Limbs

This patient developed a type III endoleak due to component separation of the left iliac limb from a prior EVAR. To repair this, our physicians first used an Excluder limb across both graft defects followed by a second Excluder limb in the patient's iliac, to bridge the separation of components. I would normally code this with 34825, 75953.

However, I am not sure how to code for a second graft in this case or if I can code for it at all because I am not positive that the second graft is considered a separate vessel and qualifies for the 34826. There is no mention of it being placed in either the external or internal iliac.


Read More
Posted in Free Newsletters By Sondra Dunn

ZHealth Coding Newsletter - July 2017

Jul 30, 2017 2:22:00 AM

July 2017 Q & A

Question: Superior Mesenteric Artery to Rt Hepatic Artery

A 5 Fr sheath was placed and attached to a heparinized saline infusion. Exchange was made for a SOS catheter and selective DSA performed in the superior mesenteric artery. Superselective catheterization of the replaced right hepatic artery was then performed using a 3 Fr Progreat Microcatheter and wire. Can a catheter reach the right hepatic artery from the SMA or does the catheter need to go through the celiac artery?

Read More
Posted in Free Newsletters By Sondra Dunn

ZHealth Coding Newsletter - June 2017

Jun 29, 2017 2:22:00 AM

June 2017 Q & A

Question: Coarctation of Aorta and Bicuspid Aorta Valve

I have a provider that is is trying to tell us that if a patient has a coarctation of the aorta and a bicuspid valve then we need to bill the congenital CPT codes. I noticed that you answered a similar question in March, but I was wondering where you got your information so I can provide that information to my provider.

Read More
Posted in Free Newsletters By Sondra Dunn

ZHealth Coding Newsletter - May 2017

May 28, 2017 2:22:00 AM

May 2017 Q & A

Question: 96374 with an Ablation

We had a case where Ibutilide was administered during an atrial flutter ablation procedure (93653). The Medicare claims processing manual, chapter 4, section 230.2 discusses this and says, "Hospitals should report all HCPCS codes that describe the drug administration services provided, regardless of whether or not those services are separately paid or their payment is packaged." 93653 had a "J1". 96374 has an SI of "S".

In your opinion, Ibutilide is inherent or not inherent to an ablation procedure, in which it's not always used as part of the procedure, to lets say contrast to an diagnostic angiography, is it then ok to bill 96374 for an IV push, and 96365 for an infusion, if they are given Ibutilide as part of an ablation for a flutter or A-Fib?

Read More
Posted in Free Newsletters By Sondra Dunn

ZHealth Coding Newsletter - April 2017

Apr 20, 2017 2:22:00 AM

April 2017 Q & A

Question: Left Dorsalis Pedis an Additional Artery on Left Anterior Tibial?

An angioplasty was performed on the left dorsalis pedis artery...an angioplasty with atherectomy was performed on the left anterior distal tibial artery. Is the left dorsalis pedis angioplasty an add-on to code 37229, or is it part of code 37229? Is just code 37229 reported, or 37232 and 37229?

Read More
Posted in Free Newsletters By Sondra Dunn

ZHealth Coding Newsletter - March 2017

Mar 17, 2017 2:22:00 AM

March 2017 Q & A

Question: Treating Tibioperoneal Trunk with PTA and SFA

I have heard that it may be possible to code for an intervention in the tibioperoneal trunk in the following two scenarios: 1. It is the only vessel treated; 2. It is separately treated in addition to an intervention in the anterior tibial artery. My patient has focal stenoses of the mid and distal SFA treated with angioplasty. A patent popliteal artery. Focal high grade stenoses in the superior aspect of the tibioperoneal trunk and within the distal tibioperoneal trunk at the bifurcation of the peroneal and tibial artery. These stenoses were treated with angioplasty as well.

Can I report code 37228 for the tibioperoneal trunk in addition to the SFA angioplasty (37224)? I'm a bit confused because the CPT code book indicates the tibioperoneal trunk would be considered part of the tibial/peroneal territory, but not a separate 4th segment of vessel. Does this mean if it is the only segment of vessels in the tibial/peroneal territory it is billed? Even if another territory is billed? 


Read More
Posted in Free Newsletters By Sondra Dunn

February 2017 Q & A

Question: C2623 vs 37220

We have been getting edits when codes C2623 (Catheter, transluminal angioplasty, drug-coated, non-laser) and 37220 (Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal angioplasty) are on the same claim, but I can find nothing to indicate that this code pair should create an edit. Edit reads: when C2623 is on the claim then 37224 or 37226 must also be on the claim?

Read More
Posted in Free Newsletters By Sondra Dunn

Special Edition Newsletter: Moderate Sedation

Revision to 'Professional Billing of Moderate Sedation by the Physician Performing the Procedure When in a Facility Site of Service'

The codes for reporting moderate sedation performed by a physician or other qualified health care professional other than the one performing the procedure do not have different RVUs for the facility and non-facility sites of service. The RVUs are the same. There is also an NA in the NON-FAC NA INDICATOR column of the RVU file. From the CMS document explaining the NA in this field: An “NA” in this field indicates that this procedure is rarely or never performed in the non-facility setting.

Read More
Posted in Free Newsletters By Sondra Dunn

January 2017 Q & A

Question: 32551 vs 32557

IR chest tube placement. 

Indication: Large symptomatic right pneumothorax status post CT-guided lung biopsy. 

Technique: The patient was placed supine on the fluoroscopy table. The right hemithorax was prepped and draped in a sterile fashion. The fifth and sixth rib interspace was localized with fluoroscopy, and 1% lidocaine was utilized for local anesthesia. A Cook pneumothorax 9 French drainage catheter was placed into the right pleural space using a trocar under direct fluoroscopic surveillance. The drain was then connected to a Heimlich valve, and good reexpansion of the right lung was achieved after the patient coughed. Postprocedural images demonstrate a small residual right apical pneumothorax with the drainage catheter overlying the anterior midlung zone. 

Impression: Successful placement of 9 French chest tube with satisfactory re-expansion of the right lung.

Read More
Posted in Free Newsletters By Sondra Dunn

Items 1 to 10 of 86 total

Page:
  1. 1
  2. 2
  3. 3
  4. 4
  5. 5
Set Descending Direction